Effective Anxiety and Depression Management Techniques: A Personal Journey
Reviews the practices that work best to support a resilient mind that remains in a state of low agitation even as the turbulent flow of life surrounds me.
Last Updated: 07 May 2024
Background
I've had anxiety and depression for over 50 years. For around 30 of those years it was debilitating. I found this frustrating and puzzling and at time I experienced strong feelings of anger and despair.
In my 20s and 30s I followed medical advice that centered around exercise and medication and I also followed the advice of my spiritual teachers and friends. I found beta blockers helped with my heart palpitations, but did not find Atavan (a benzodiazepine) to have much effect at all. Likewise I did not receive much help from traditional healing practices such as petitionary prayer, anointing with oil, laying on of hands, the rosary, breathwork, or therapeutic touch. I tried them all.
Beginning in 2007 I started on a new path. When my father died that year, I went to see a psychiatrist for the first time. He was an older man who was seeing me on his last day before retiring and he seemed particularly thoughtful and present. He gave me advice that turned out to be the most helpful I received. He told me that for my particular presentation, he would recommend something he didn't recommend often, depth psychology. I had studied Freud, Jung and Adler and while interesting, I didn't think there was much scientific evidence that their therapies worked any better than talking over the fence to a neighbor. So I did not take his advice. Instead I avoided my anxiety by immersing myself in a large project. I launched my 100 lakes project, and began to follow my intuition about what was healing and what was not. While the project was important for my grieving process, and gave me a creative outlet, I eventually return to my search for a solution. My new psychiatrist recommended schema therapy, which in 2013 proved to be very helpful.
The success of schema therapy was, unfortunately, limited, because it did not address the basic core of my anxiety, which for me is a fear of the loss of meaning and purpose. That was what the 100 lakes project had provided.
My goal since 2014 has been to integrate the practices that work best to support a resilient mind; one that remains in a state of low agitation even as the turbulent flow of life surrounds me. This stronghold home-base, this calm aliveness, is a place to return to and rest in as needed. The idea is to practice the state I most want to be in most of the time, so that I can engage in the difficult and challenging things of life, which also tend to be the most meaningful.
Below is my ongoing list. I've tried to arrange these from most effective to least effective.
Technique: Welcoming Prayer
Effectiveness (1-5): 5
Why or why not: One of the clever paradoxical disciplines that confronts the subconscious with my deepest fears and releases some of the power those fears have over me. It more reliably and consistently calms my nervous system than mindfulness or meditation. 1st blog post about my experience with it
Comments: This almost unheard of gem of a practice is my number 1 recommendation for helping bring wants, needs and desires into consciousness. It is at core a technique for letting go of desires by welcoming them. I use it most at night when I am ruminating about the day and can't sleep. It works particularly well for that.
Technique: Heaven and Hell Lists, and the Reverse Bucket List
Effectiveness (1-5): 5
Why or why not: This is a practice I started a couple of years ago that lines up with the welcoming prayer. The idea is to imagine the worst case future you want to avoid, and the best case future you want to reach. Then you create two lists. The heaven list is the future you want, and the hell list is the future you want to avoid. The twist is that the heaven list is not just a list of things or experiences like a traditional bucket list, but instead is a list of the things that will give a sense of purpose and meaning, and that align with your values.
Comments: This practice is based in Jordan Peterson's Self Authoring program, and Arthur Brooks' idea of a reverse bucket list. Brooks asks "Would those things I crave actually bring me closer to my vision of the good life?" Brooks says the future state you imagine should be one that lines up with your values and gives you a sense of psychological peace. Lastly, he talks about the importance of simplifying and taking away things from your life, rather than adding things or experiences. This is paradoxical, and is a good complement to the Welcoming Prayer, which helps clarify what your desires are to assist with letting go of them. Once you are not run by your desires, you can focus on what will truly give a sense of satisfaction for a life well lived.
Technique: The 4 Ways of Being
Effectiveness (1-5): 5
Why or why not: Clearly shows that living with the "victim voice" keeps you trapped below "the line" and shows that perceived threat is driving thinking and behavior. The transition to a "by me" and "through me" perspective is a move towards that state of tranquility in which threats and the judgements of others are seen as those people's own states, and not necessarily anything true about you.
Comments: When I catch myself in the "to me" mindset I remind myself that it is a limiting perspective robbing me of agency and freedom. I look for what is going on in the other person that is making them defensive or aggressive, believing that most people are aggressive or defensive when they feel threatened. The exception to this is people on the narcissistic-sociopath-psychopath spectrum. With them I shift my persona and raise my boundaries.
Technique: Forest Bathing
Effectiveness (1-5): 5
Why or why not: A combination of exercise, escape, quiet, fresh air, natural cannabinoids, and visually calming patterns works to create a strong reduction in anxiety. A very well known and overused term, it nevertheless is effective.
Comments: Part of my regular health routine, time in forests has a noticeable calming effect for me. This is one of the longest forms of therapy I have used, stretching back to my childhood when I would spend many hours alone in nature. While it can be a form of avoidance, it can also be the treat or reward you give yourself for getting through the week. It is a restorative part of my recovery model.
Technique: Tension Myositis Syndrome (TMS) Exercises
Effectiveness (1-5): 5
Why or why not: According to TMS theory, the primary cause of chronic pain is not structural abnormalities in the body (such as herniated discs or degenerated joints) but rather repressed emotions (particularly rage) and psychological stress. Dr. Sarno proposed that the brain creates pain either as a distraction mechanism to divert attention away from unconscious, overwhelming emotions, or as a strategy to get our attention that something is really bothering us, but that we are not aware of it.
Comments: By practicing TMS exercises I was able to end back pain for many years. It has re-occurred many times, most recently last week! By returning to the exercises, I am able to relieve most of the pain. The exercises involve self-talk and journaling. The self-talk is to remind ourselves that the pain is in the brain, rather than the body (assuming physical damage or illness has been ruled out). The journaling is a process of uncovering what we are repressing. What I like about this practice is that it is a way to become aware of the inner responses that are causing pain, rather than outer impacts. Our pain, both mental and physical, is a response from our body (see Van der Kolk and Mate) and not some weakness in our thinking or lack of courage.
Technique: Medication
Effectiveness (1-5): 5
Why or why not: Beta blockers helped my racing and irregular heart beats, which in turn calmed my anxieties about the symptoms. Trintellix has significantly reduced ruminations and sensing threats in social situations.
Comments: Some medication was ineffective for me, including Lorazepam (Ativan) which seemed to have no noticeable effect. Trintellix, while effective, also seems to dull my ability to experience wonder, fascination, and joy. While effective, medication has lots of problems and many people (Pearson – Anxiety) recommend avoiding it.
Technique: Internal Family Systems Theory
Effectiveness (1-5): 5
Why or why not: IFS has not been significantly effective at reducing immediate experiences of anxiety, but it has been an important addition to my practices because it lines up very well with TMS. In TMS the source of the pain is seen to be repressed anger or rage. In IFS the source of the pain is a variety of emotions and experiences carried by different parts of our overall person. These parts can be communicated with and long-standing impasses can be overcome through a friendly and confident building of the internal family.
Comments: In a recent bout of pain brought on by medication, I realized I had not been doing any TMS or IFS work, so turned inward to uncover what the cause of the current pain was. I discovered first a protector named avoidance, and then a protector named anxiety, before uncovering an exile named Roar. Roar emerged from a dark hole like a strange hulk figure, knocking several smaller parts over that were watching it down the hole. It had a large head with several smaller heads and I immediately knew this was the repressed rage. I knew it was an exile because it said "roar" instead of making a roar. My job now is to work with Avoidance and Anxiety to get to know Roar and see how to befriend and integrate it better into the internal family.
Technique: Flow States (writing, paddling, photography)
Effectiveness (1-5): 4
Why or why not: The flow state itself seems to balance the nervous system by taking me out of rumination and threat response. The most reliable generator of a sense of integration and clarity of mind.
Comments: Another effective strategy that crosses over into nature therapy for me. Creative writing and listening for inspiration can be a form of medication.
Technique: Meta Cognitive Therapy
Effectiveness (1-5): 4
Why or why not: By developing metacognitive awareness, that is, awareness of the patterns of your thinking, you can learn to disengage from unproductive rumination and shift towards more adaptive cognitive strategies. In particular it is helpful to see that rumination is only helpful for short periods. Continuing to think about an event or perception without seeking more information only leads to story making and reinforces the threat response. It is better to limit rumination to set times.
Comments: One of the most dramatic therapies I have tried. It brought about a significant reduction in symptoms within days. Many people find this therapy to be sufficient and consider it to be a "cure" for anxiety and depression. Unfortunately, I was not able to maintain the practice without the help of medication. With both medication and MCT I can live almost anxiety and depression free.
Technique: Hawthorn Supplements
Effectiveness (1-5): 4
Why or why not: Remarkably, this simple remedy of three capsules of hawthorn per day has powerfully regulated my heart and strengthened it.
Comments: At times I have stopped taking the supplements, but generally have found that I experience more arrhythmia over a period of several weeks.
Technique: Mind Body Code
Effectiveness (1-5): 4
Why or why not: Mario Martinez's work on the connection between our mind and body, and how they influence each other. According to Martinez, emotions and cultural factors can affect the body's cellular structure and function, contributing to both health and illness. The Mind-Body Code encourages individuals to explore and transform limiting cultural and personal beliefs that may be impacting their well-being.
Comments: Different than positive thinking, the Mind Body Code is more about using psychological knowledge to resist the messages that culture, family, and advertisers are giving us that are not helpful. I found Dr. Martinez's teachings to remind me to notice and reject messages that are either not true or are harmful. The challenge is to create healthy beliefs based in facts.
Technique: Walking
Effectiveness (1-5): 4
Why or why not: The number one exercise for losing belly fat.
Comments: Walking has always been an effective way to reduce anxiety. It has something to do with the rhythm of the walking as well as the gentle increase in heart rate. It seems to be less triggering of heart arrhythmia than running or other exercises.
Technique: Deconstructing Anxiety
Effectiveness (1-5): 4
Why or why not: Fear distorts our perception of reality and truth. Deconstructing Anxiety is a procedure to discover our core fear and chief defense. Then we can do the opposite of our chief defense and become better aligned with reality and our true self. Most of the time we push away what we don't want or don't like. But instead of freeing ourselves from fear, this pushing away leads to a life of defense and avoidance.
Comments: The key message is that identifying resistance as the source of suffering unlocks a series of responses that can change your perception of reality and how you respond to it. The goal is to let go of both our core fear and our chief defense and instead accept what is, and navigate accordingly.
Technique: Sleep
Effectiveness (1-5): 3
Why or why not: Getting sufficient sleep is vital to coping with anxiety and stress, and unfortunately is often reduced when anxious.
Comments: Sleep can be an avoidance strategy, especially in depression.
Technique: Schema Therapy
Effectiveness (1-5): 3
Why or why not: Maps out the common schemas and how to counteract their hold on the mind through challenging their reality and looking at facts. For me, the defectiveness schema responded to this approach. This was a powerful lesson in the value of questioning my internal narrative, informed as it usually is by the negativity bias. Unfortunately this method tends to address errors in thinking with more thinking, or with attempts to change thinking by thinking differently. It reinforces the very behaviour that is causing us problems.
Comments: I practiced this therapy intensively twice, once with success and once without success. It does not easily allow for honest negative appraisals, which can be healthy and valid. The strength of the therapy is to show that once established, we use the confirmation bias to continually reinforce a limiting, inaccurate, or unbalanced belief.
Technique: Vision and Purpose Statements
Effectiveness (1-5): 3
Why or why not: A weekend retreat helped me understand how the vision and purpose statements were best constructed to provide real motivation. I memorized them to recite to myself whenever I'm tempted to try to be something that is not true to who I am.
Comments: I first did this workshop in 2004 and found it helped immediately with anxiety. The effect is small but consistent. The woman who pioneered the process has retired and now the only similar program available is for women, but I believe the strategy is helpful for everyone.
Technique: Mindfulness
Effectiveness (1-5): 2
Why or why not: Various techniques for placing attention on the body or environment. The idea is to move attention away from the content of our thoughts onto simple sensations, and to help us "be" more in our body. While hugely popular after Jon Kabat-Zinn translated the practice for western consumers, I have never found it to provide much relief.
Comments: I took 12 weeks of training in various mindfulness meditation techniques and found yoga and Qigong to be most helpful, but compared to other techniques, they did not appeal to me.
Technique: Labyrinths
Effectiveness (1-5): 2
Why or why not: A form of mindfulness in which a pattern on the floor or ground is followed with something similar to walking meditation. Paying attention to the feelings as we move through the labyrinth. Helpful as a spiritual discipline to shift our way of seeing things as a series of choices, to seeing a larger path, it nevertheless was not very effective at reduction of anxiety or depression, for me.
Comments: Labyrinths, unlike mazes, do not have wrong turns, but they do have unexpected turns. Part of the effect is that they show that events have a beginning and an end, and our experience of any sequence of events is often that of not having a lot of choice, so we might as well enjoy the process.
Technique: Therapeutic Touch
Effectiveness (1-5): 2
Why or why not: Therapeutic Touch (TT) is a complementary therapy that involves practitioners using their hands to supposedly influence, direct, or manipulate the energy field around a person's body. Practitioners typically move their hands in sweeping motions above the body without direct physical contact. TT is used in various healthcare settings for relaxation and stress reduction, and for physical healing.
Comments: I have had some positive experiences with TT but overall find it to be problematic because I don't find a lot of scientific support for it. It is likely that the placebo effect is a significant part of its effectiveness.
Technique: Eating and Diet
Effectiveness (1-5): 2
Why or why not: Reducing caffeine had a big effect early in my recovery journey. I found that the caffeine in tea did not affect me in the same way as coffee and I drink a lot of tea now without noticeable effect. Meals that fit the Zone diet, the Keto diet, and the Carnivore diet reduce anxiety and improve cognitive functioning.
Comments: Eating as self-soothing has short-term but generally unhelpful effects. Ketogenic diets have been used to treat mental health disorders with great success.
Technique: Exercise
Effectiveness (1-5): 2
Why or why not: Burning off adrenaline and producing a feeling of calm can both be beneficial results. Self-esteem can be given a boost as well, due to the development of resiliency and a stronger physique. Strength has a known association with general health and is a predictor of longevity.
Comments: Exercise can become a form of dependency, and can be a symptom of "running away from our problems." I found strenuous exercise exacerbated my heart palpitations and so I focused on walking and similar activities instead. Slow and steady walking without heavy breathing has a rhythm that stabilizes heart rates and increases an overall state of calm.
Technique: Inter-muscular stimulation
Effectiveness (1-5): 1
Why or why not: Intramuscular stimulation (IMS) is a technique that physiotherapists use to release or lengthen muscles that may be causing chronic musculoskeletal or neuropathic pain. Very fine needles (similar ones to those used in acupuncture) are inserted directly into the affected muscle, in order to stimulate healing. This is also often referred to as “dry needling.”
Comments: I received a series of these treatments over several months and obtained relief that lasted from days to weeks. The underlying cause of the pain, in my case, was neurological in nature. All pain is a response in the brain and other neural tissue to signals received from parts of the body that have been injured, and the signals can get confused with other signals. The solution for me was treatment for TMS (see above).
Technique: Watch the Breath Meditation
Effectiveness (1-5): 1
Why or why not: "Pranayama" involves conscious regulation of breath and is mentioned in texts like the Upanishads, which date back over 2,000 years. Similarly, early Buddhist teachings, particularly in the Theravada tradition, emphasize mindfulness of breath as a foundational meditation practice. The "Anapanasati Sutta," a discourse attributed to the Buddha, provides detailed instructions on mindfulness of breath. Ancient Daoist traditions also incorporated breath awareness in their meditation practices. The Daoist concept of "Daoist breathing" or "Daoist breath control" involves mindful attention to the breath to cultivate vital energy (qi).
Comments: I found breath meditation to be of limited help and initially I found that it increased my physiological symptoms, especially heart palpitations. I eventually was able to incorporate it into my practice after someone encouraged me to watch a baby breathe when they are sleeping. I noticed that the breathers were relatively shallow, but from the belly. It turned out I was breathing in too deeply and that was triggering my palpitations. This may be particularly ineffective because of my lung disease. As a meditation tool, however, this practice is useful, just not for the reduction of anxiety and depression.
Technique: Breathwork
Effectiveness (1-5): 1
Why or why not: Controlling the breath through a variety of techniques including "box breathing" and the 4-7-8 technique taught by Dr. Weil.
Comments: While this is an effective anti-anxiety technique, it does not work when you are highly anxious and instead can make the feeling of being light-headed worse.
Technique: Distraction
Effectiveness (1-5): 1
Why or why not: Entertainment, activity, social interaction, eating, and a host of other activities that are pleasurable and take our mind off our troubles for a period of time. Easy to practice and relatively effective for minor bouts of rumination and anxiety, but it does not address underlying issues and does not work very well for those who like to process deeply.
Comments: Despite this being seen by some as an un-healthy response, I instead see it as a technique that has its place, as long as it is not overused. In the long run, it is more of a coping technique than a treatment option for introverts. On the other hand, I know some people who use distraction as their number 1 strategy with great success. These tend to be extroverts and proactive people who like to be constantly stimulated and busy.
Technique: Traditional Prayer
Effectiveness (1-5): 1
Why or why not: This large category of practices includes supplication, laying on of hands, anointing with oil, mantras, prayer beads and rosaries.
Comments: I find prayer to be slightly effective in reducing anxiety in group settings, especially when the process has a ritualistic or chanting style. I like using beads, and know that many find bead prayers to be healing, they just have not been for me.